@layout("/common/_form.html",{js:["/assets/modular/system/btyDzd/btyDzd_add.js"]}){

<form class="layui-form" id="noticeForm" lay-filter="noticeForm">
    <div class="layui-fluid" style="padding-bottom: 75px;">
        <div class="layui-card">
            <div class="layui-card-header">基本信息</div>
            <div class="layui-card-body">
                <div class="layui-form-item layui-row">
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">店名<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <select name="dm" lay-filter="dm" id="dm" lay-search="">
                                <option value=''>全部</option>
                            </select>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">报销人<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <select name="btyBxdaId" lay-filter="language" id="btyBxdaId" lay-search="">
                                <option value=''>全部</option>
                            </select>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">支出金额<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input name="zcje" placeholder="支出金额" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
<!--                    <div class="layui-inline layui-col-md12">-->
<!--                        <label class="layui-form-label">银行卡号<span style="color: red;">*</span></label>-->
<!--                        <div class="layui-input-block">-->
<!--                            <input name="yhk" placeholder="请输入银行卡号" type="text" class="layui-input" lay-verify="required" required/>-->
<!--                        </div>-->
<!--                    </div>-->
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">摘要<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input name="zy" placeholder="请输入摘要" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12">
                        <label class="layui-form-label">备注<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <textarea name="bz" placeholder="请输入备注" class="layui-textarea"></textarea>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md12 uploadHeadImage">
                        <label class="layui-form-label">图片<span style="color: red;">*</span></label>
                        <div class="layui-input-block">
                            <input type="hidden" name="picture" id="picture">
                            <div class="layui-upload">
                                <button type="button" class="layui-btn" id="upload_btn"><i class="layui-icon">&#xe64a</i>上传图片</button>
                                <div class="layui-upload-list">
                                    <div id="layer-photos-demo" class="layer-photos-demo">
                                    </div>
                                    <p id="msgText"></p>
                                </div>
                            </div>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
    <div class="form-group-bottom text-center">
        <button class="layui-btn" lay-filter="btnSubmit" lay-submit>&emsp;提交&emsp;</button>
        <button type="reset" class="layui-btn layui-btn-primary" ew-event="closeDialog">&emsp;取消&emsp;</button>
    </div>
</form>

@}
